Provider Demographics
NPI:1245344878
Name:BAINE, JENNIFER SWINDLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SWINDLE
Last Name:BAINE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-1309
Mailing Address - Country:US
Mailing Address - Phone:254-897-3369
Mailing Address - Fax:254-898-1157
Practice Address - Street 1:409 GLENWOOD
Practice Address - Street 2:STE 500
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-1309
Practice Address - Country:US
Practice Address - Phone:254-897-3369
Practice Address - Fax:254-898-1157
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-08-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP57812Medicare UPIN
87N853Medicare ID - Type Unspecified